Catalan Public Health Research Articles

Perceptions of COVID-19 Maternal Vaccination among Pregnant Women and Healthcare Workers and Factors That Influence Vaccine Acceptance: A Cross-Sectional Study in Barcelona, Spain.

COVID-19 is associated with poor maternal and pregnancy outcomes. COVID-19 vaccination is recommended in Spain, yet vaccination rates in pregnancy are suboptimal. This study investigates the perceptions of pregnant women and healthcare workers (HCW) regarding COVID-19 vaccination. A web-based cross-sectional quantitative study was conducted in 2021-2022 among 302 pregnant women and 309 HCWs in the Catalan public health system. Most pregnant women (83%) and HCWs (86%) were aware of COVID-19 maternal vaccines. The recommendation of the COVID-19 vaccination by an HCW was identified as the greatest facilitator for maternal vaccine uptake, while the fear of harming the foetus was the most significant barrier reported for rejecting vaccination. HCWs recognised they received limited information and training about COVID-19 vaccination in pregnancy, which hindered them from providing informed recommendations. This study highlights that information and education on COVID-19 vaccines to pregnant women and health professionals are pivotal to ensuring informed decision-making and increasing vaccine uptake.

DOP05 Morbid obesity, a new susceptibility factor for developing Inflammatory Bowel Disease. Results of a population-based study

Abstract Background Some genetic polymorphisms (present in less than 30% of patients) and environmental factors, such as tobacco exposure, have been identified to increase the susceptibility for developing inflammatory bowel disease (IBD), but it is suspected that there may be other still unknown environmental or epidemiological factors. In this sense, some studies suggested an increased incidence of IBD in individuals undergoing bariatric surgery (BS) for morbid obesity (MO). We aimed to assess whether BS or MO are associated with an increased risk of developing IBD. Methods All individuals resident in Catalonia (7.7 million inhabitants in 2021) with a diagnosis of obesity or MO within the period 2005–2020 were identified from the Catalan Public Health System Database. Children under the age of 18 and those diagnosed with IBD prior to the diagnosis of obesity or MO were excluded. Individuals BS and those with a new diagnosis of IBD were identified, and the likelihood of developing IBD was analyzed by Kaplan-Meier survival analysis. A Cox regression multivariable analysis was performed to assess independent risk factors for the development of IBD, Crohn’s disease (CD) and ulcerative colitis (UC). Results Three cohorts were identified: 94,473 individuals with MO; 1,009,256 with obesity; and 14,698 who underwent BS during the study period. A total of 4,277 new diagnoses of IBD were identified, of which 78 among individuals who underwent BS prior to IBD diagnosis (0.84 cases per 1000 person-years), 409 among individuals with OM but without BS (0.90 cases per 1000 person-years), and 3,790 in obese individuals (0.60 cases per 1000 person-years). The likelihood of developing IBD was significantly higher in patients with MO as compared with obese patients (HR 1.46; 95%CI 1.32–1.62). These differences were maintained when the likelihood of developing CD or UC were assessed separately. In the multivariable logistic regression analysis, MO (HR 1,68; CI95% 1.41–1.99), female gender (HR 1.17; 95%CI 1.05–1.31) and active smoking (HR 1.62; 95%CI 1.43–1.84) were associated with an increased risk of CD. In UC, MO (HR 1,36; 95%CI 1.19–1.55) and BS (HR 2.62; 95%CI 1.34–2.11) were independent risk factors, whereas female gender (HR 0.86; 95%CI 0.79–0.93) was an independent protective factor. Conclusion MO is an independent risk factor for the development of IBD, for both CD and UC, whereas BS seems to increase the risk only for UC.

The resetting of a local health system: an opportunity for health promotion

BackgroundThe COVID-19 pandemics brings a window of opportunity for the 2021-2025 Health Plan of Catalonia to better address the social determinants of health. Different public organisms are leading the Health Promotion (HP) agenda without a real integration of the approach. An interdisciplinary group of health professionals working on HP carried out a qualitative study to assess barriers, facilitators and recommendations of health professionals and public policy managers for applying HP.MethodsSix focus groups with 52 purposively selected professionals of different health disciplines and three in-depth interviews with public policy managers were conducted between March 2017-February 2020 until saturation was reached. An external expert on Sociology conducted all interviews and codification was done by three researchers from the group. Literature review helped to complete triangulation.ResultsThe salutogenic approach was mostly unknown. The health system was not set with a people-centred perspective and HP not integrated within health services. Different public organisms competed for leadership and resources in HP. There was limited expenditure for the primary health care services working on HP. Coordination across healthcare services levels and sectors was scarce. Roles and responsibilities related to HP were not defined. Health professionals were not aware of evidence-based approaches. Some interdepartmental public health plans were already designed but not fully deployed, mainly due to lack of funding and disaggregated mechanisms of governance and financing. Initiatives such as the Municipal Health Committees or social prescription were positively perceived.ConclusionsThe Catalan Public Health Agency and health providers should work aligned. Financing and reallocation of resources for Public Health and HP should be enhanced. Health should be a core value in educational plans. Local and regional stakeholders should have a higher role in resetting health services.Key messages Governance for Health in All Policies needs intersectoral partnerships.The health system should be rebuilt to properly address the social determinants of health in the post-COVID era.

Characteristics of Citizens and Their Use of Teleconsultations in Primary Care in the Catalan Public Health System Before and During the COVID-19 Pandemic: Retrospective Descriptive Cross-sectional Study.

BackgroundeConsulta—that is, asynchronous, two-way teleconsultation in primary care—is one of the most important telemedicine developments in the Catalan public health system, a service that has been heavily boosted by the onset of the COVID-19 pandemic. It is vital to know the characteristics of its users in order to be able to meet their needs and understand the coverage of this service in a context where there is reduced accessibility to the health system.ObjectiveThis study aims to analyze the profile of the citizens who use the eConsulta tool and the reasons for their use, as well as to gain an understanding of the elements that characterize their decision to use it while distinguishing between those who used it before and those who have used it since the onset of the COVID-19 pandemic.MethodsA descriptive, observational study based on administrative data was performed. This study differentiates between the COVID-19 pandemic era and the period preceding it, considering the day the state of emergency was declared in Spain (ie, March 12, 2020) as the cut-off point. It also differentiates between eConsulta users who send messages and those who only receive them.ResultsDuring the pandemic, the number of unique users of this teleconsultation service had almost tripled, with up to 33.10 visits per 1000 inhabitants per month reported in the first three months. For the two user profiles analyzed, most users since the start of the COVID-19 outbreak were predominantly female, systematically younger, more actively employed, and with less complex pathologies. Furthermore, eConsulta users received more messages proactively from the health professionals. There was also a relative decrease in the number of conversations initiated by higher-income urban users and an increase in conversations initiated by users in rural areas.ConclusionsThe COVID-19 pandemic has helped to generalize the use of telemedicine as a tool to compensate, to some extent, for the decline in face-to-face visits, especially among younger citizens in Catalonia. Telemedicine has made it possible to maintain contact between citizens and the health care system in the context of maximum complexity.

Quantifying the under-reporting of uncorrelated longitudal data: the genital warts example

BackgroundGenital warts are a common and highly contagious sexually transmitted disease. They have a large economic burden and affect several aspects of quality of life. Incidence data underestimate the real occurrence of genital warts because this infection is often under-reported, mostly due to their specific characteristics such as the asymptomatic course.MethodsGenital warts cases for the analysis were obtained from the Catalan public health system database (SIDIAP) for the period 2009-2016. People under 15 and over 94 years old were excluded from the analysis as the incidence of genital warts in this population is negligible. This work introduces a time series model based on a mixture of two distributions, capable of detecting the presence of under-reporting in the data. In order to identify potential differences in the magnitude of the under-reporting issue depending on sex and age, these covariates were included in the model.ResultsThis work shows that only about 80% in average of genital warts incidence in Catalunya in the period 2009-2016 was registered, although the frequency of under-reporting has been decreasing over the study period. It can also be seen that this issue has a deeper impact on women over 30 years old.ConclusionsAlthough this study shows that the quality of the registered data has improved over the considered period of time, the Catalan public health system is underestimating genital warts real burden in almost 10,000 cases, around 23% of the registered cases. The total annual cost is underestimated in about 10 million Euros respect the 54 million Euros annually devoted to genital warts in Catalunya, representing 0.4% of the total budget.

Patterns of Admission and Outcomes for Patients with Intracranial Hemorrhage in Catalonia, Spain

Limited information is available about the hospital types to which patients with intracerebral hemorrhage (ICH) are admitted and treated. This could be important because some effective therapeutic measures can only be administered at comprehensive stroke centers (CSCs). Using the Acute Hospitals Discharge database, which provides population-based information, we identified ICH patients admitted to 7 CSCs and 53 non-CSCs (from January 2015 to December 2016) in Catalonia. CSCs were defined as centers with an emergency department ready to assess and treat code stroke patients around the clock, 24-hour availability of neurology, neurosurgery, and neuroradiology services, and admission to the stroke unit and/or intensive care unit. The database provided the demographics, admitting hospital, and interhospital transfers. Vital status was retrieved from the Central Registry of the Catalan Public Health Insurance. A total of 3339 ICH patients were identified (mean age, 72.2 ± 14.6 years; 56.8% men). Of the 3339 patients, 45.7% were admitted to a CSC and 54.3% to a non-CSC. Transfer from a non-CSC to a CSC occurred for 1.97% of the patients. In-hospital mortality was similar between the CSCs and non-CSCs (30.2% vs. 27.5%; P= 0.09). The long-term mortality was also comparable between the CSC and non-CSC groups (45.4% vs. 47%; P= 0.34). Despite a considerable proportion of ICH patients remaining at a non-CSC for their entire hospitalization, the short- and long-term mortality were comparable between the 2 hospital types. More studies are required to determine whether outcomes other than mortality might be related to the admitting hospital type and whether the routing protocols for ICH patients should be modified.

Approach to the Status and Management of Languages in the Catalan Public Health Care System

This article deals with the situation of languages in healthcare in Catalonia. It reports on the measures being carried out by the Ministry of Health of the Government of Catalonia to guarantee that the population may be attended to in their own official language, whether Catalan, Spanish or Occitan, and specifically to promote knowledge and use of Catalan among professionals working in the health system. It provides data on the migratory flows of doctors and nurses and sociolinguistic data. Other sections deal with healthcare services provided in non-official languages and in Catalan sign language, as well as language-related complaints and the measures implemented to make Catalan a suitable and prestigious language for medical and scientific communication. It concludes by listing the challenges that still need to be tackled to give Catalan greater presence and to raise its status in the field of health.

Evolució de les guies alimentàries a Catalunya

Dietary guidelines are educational tools based on scientific evidence and on the characteristics of the target population. They must make it easier for people to make better food choices and therefore improve their health, as well as take better care of their environment. The first guidelines used different graphic ideas, until the triangle or pyramid was popularised in the 1990s and remained as the representation of reference for decades. Lately, the healthy plate has complemented or replaced the pyramid in many contexts, despite the fact that other organisations have chosen to change the approach and design different and innovative guidelines, as is the case with the Catalan Public Health Agency.

Primary Care Doctor Characteristics That Determine the Use of Teleconsultations in the Catalan Public Health System: Retrospective Descriptive Cross-Sectional Study.

BackgroundeConsulta is a tele-consultation service involving doctors and patients, and is part of Catalonia's public health information technology system. The service has been in operation since the end of 2015 as an adjunct to face-to-face consultations. A key factor in understanding the barriers and facilitators to the acceptance of the tool is understanding the sociodemographic characteristics of general practitioners who determine its use.ObjectiveThis study aimed to analyze the sociodemographic factors that affect the likelihood of doctors using eConsulta.MethodsA retrospective cross-sectional analysis of administrative data was used to perform a multivariate logistic regression analysis on the use of eConsulta in relation to sociodemographic variables.ResultsThe model shows that the doctors who use eConsulta are 45-54 years of age, score higher than the 80th percentile on the quality of care index, have a high degree of accessibility, are involved in teaching, and work on a health team in a high socioeconomic urban setting.ConclusionsThe results suggest that certain sociodemographic characteristics associated with general practitioners determine whether they use eConsulta. These results must be taken into account if its deployment is to be encouraged in the context of a public health system.

Prevention of sudden death in adolescent athletes: Incremental diagnostic value and cost-effectiveness of diagnostic tests.

Introduction Pre-participation screening in athletes attempts to reduce the incidence of sudden death during sports by identifying susceptible individuals. The objective of this study was to evaluate the diagnostic capacity of the different pre-participation screening points in adolescent athletes and the cost effectiveness of the programme. Methods Athletes were studied between 12-18 years old. Pre-participation screening included the American Heart Association questionnaire, electrocardiogram, echocardiogram, and stress test. The cost of test was established by the Catalan public health system. Results Of 1650 athletes included, 57% were men and mean age was 15.09 ± 1.82 years. Positive findings were identified as follows: in American Heart Association questionnaire 5.09% of subjects, in electrocardiogram 3.78%, in echocardiogram 4.96%, and in exercise test 1.75%. Six athletes (0.36%) were disqualified from participation and 10 (0.60%) were referred for interventional treatment. Diagnostic capacity was assessed by the area under the curve for detection of diseases that motivated disqualification for sport practice (American Heart Association questionnaire, 0.55; electrocardiogram, 0.72; echocardiogram, 0.88; stress test, 0.57). The cost for each athlete disqualified from the sport for a disease causing sudden death was €45,578. Conclusion The electrocardiogram and echocardiogram were the most useful studies to detect athletes susceptible to sudden death, and the stress test best diagnosed arrhythmias with specific treatment. In our country, pre-participatory screening was cost effective to detect athletes who might experience sudden death in sports.

Geographic dissemination of endovascular stroke thrombectomy in Catalonia within the 2011-2015 period.

Endovascular thrombectomy was recently established as a new standard of care in acute ischemic stroke patients with large artery occlusions. Using small area health statistics, we sought to assess dissemination of endovascular thrombectomy in Catalonia throughout the period 2011-2015. We used registry data to identify all endovascular thrombectomies for acute ischemic stroke performed in Catalonia within the study period. The SONIIA registry is a government-mandated, population-based and externally audited data base that includes all reperfusion therapies for acute ischemic stroke. We linked endovascular thrombectomy cases identified in the registry with the Central Registry of the Catalan Public Health Insurance to obtain the primary care service area of residence for each treated patient, age and sex. We calculated age-sex standardized endovascular thrombectomy rates over time according to different territorial segmentation patterns (metropolitan/provincial rings and primary care service areas). Region-wide age-sex standardized endovascular thrombectomy rates increased significantly from 3.9 × 100,000 (95% confidence interval: 3.4-4.4) in 2011 to 6.8 × 100,000 (95% confidence interval: 6.2-7.6) in 2015. Such increase occurred in inner and outer metropolitan rings as well as provinces although highest endovascular thrombectomy rates were persistently seen in the inner metropolitan area. Changes in endovascular thrombectomy access across primary care service areas over time were more subtle, but there was a rather generalized increase of standardized endovascular thrombectomy rates. This study demonstrates temporal and territorial dissemination of access to endovascular thrombectomy in Catalonia over a 5-year period although variation remains at the completion of the study. Mapping of endovascular thrombectomy is essential to assess equity and propose actions for access dissemination.

TControl: A mobile app to follow up tobacco-quitting patients

Background and ObjectiveTobacco smoking is a major risk factor for a wide range of respiratory and circulatory diseases in active and passive smokers. Well-designed campaigns are raising awareness to the problem and an increasing number of smokers seeks medical assistance to quit their habit. In this context, there is the need to develop mHealth Apps that assist and manage large smoke quitting programs in efficient and economic ways. ObjectivesOur main objective is to develop an efficient and free mHealth app that facilitates the management of, and assistance to, people who want to quit smoking. As secondary objectives, our research also aims at estimating the economic effect of deploying that App in the public health system. MethodsUsing JAVA and XML we develop and deploy a new free mHealth App for Android, called TControl (Tobacco-quitting Control). We deploy the App at the Tobacco Unit of the Santa Maria Hospital in Lleida and determine its stability by following the crashes of the App. We also use a survey to test usability of the app and differences in aptitude for using the App in a sample of 31 patients. Finally, we use mathematical models to estimate the economic effect of deploying TControl in the Catalan public health system. ResultsTControl keeps track of the smoke-quitting users, tracking their status, interpreting it, and offering advice and psychological support messages. The App also provides a bidirectional communication channel between patients and clinicians via mobile text messages. Additionally, registered patients have the option to interchange experiences with each other by chat. The App was found to be stable and to have high performances during startup and message sending. Our results suggest that age and gender have no statistically significant effect on patient aptitude for using TControl. Finally, we estimate that TControl could reduce costs for the Catalan public health system (CPHS) by up to € 400M in 10 years. ConclusionsTControl is a stable and well behaved App, typically operating near optimal performance. It can be used independent of age and gender, and its wide implementation could decrease costs for the public health system.

Providing integrated care to persons with severe intellectual disabilities living in a residential facility

Introduction: (comprising context and problem statement) Patients living in our nursing home suffer from severe intellectual disabilities (SID), need a widespread support, have legal incapacitation and their health status is characterized by aging, comorbidity, risk of complications and exacerbations, polypharmacy and high complex needs.Due to their difficult clinical management and the high intensity of interventions, there is a huge use of health and social resources.Lack of coordination is widely considered to be one of the key causes of poor quality of care, therefore primary and hospital coordination is important to avoid the negative impact derived from fragmented provision.In this context, our challenge has been to develop an integral, integrated and patient-centred approach by working on collaborative strategies involving both health and social care across different providers of the territory.Short description of practice change implemented, aims, target population and key stakeholders involved: An interdisciplinary team composed by centre professionals (manager, senior nurse, social worker and family physicians) and referent professionals from different territorial health services (general hospital, intermediate care hospital and community emergency departments), developed health and social integrated pathways aimed to:- Promote best practices in SID population, improving their quality of life.- Implement collaborative integrated care approaches.- Ensure healthcare attention adjusted to values and preferences expressed by patient’s relatives and legal representatives by an advance care planning (ACP) process.- Develop case management-based procedures.- Optimize the use of resources by reducing both avoidable admissions to hospital (specially for emergency visits and hospitalization) as well as transfers to outpatient clinics.- Create an integrative model for SID that becomes a reference for other nursing home institutions.Key findings (results, outcomes, impact) Since November 2013, 100% of persons living in our center have been identified by complexity profile and have an integral and proactive care plan to apply in case of crisis.ACP with patient’s relatives and legal representatives has been launched in 100% of patients with advanced conditions and limited life prognosis. For high complex situations, interdisciplinary care plans have been established by collaborative case conference strategies.All directives have been placed in shared electronic clinical charts that can be 7x24 consulted by all health professionals in all Catalan public health settings.Formal agreements among all agents have been conducted to implement new modes of relationship and care maps.Caregivers and family members actively participated along the project.Medical interconsultations to hospital specialists are mainly done in a remote way (with a 73% decrease in on site visits to outpatient clinics).Crisis are attended by a home-based approach, increasing the number of visits solved at the center, oftenly by intermediate care responses (68%), and finally reducing hospitalizations in a 20%.Case manager (senior nurse) ensures quality and continuity of care and excellence of transitions.Highlights: (discussions, lessons learned from the process of implementation, timeline, contingencies developed) Achieving integral needs assessment, proactive planning and a close co-ordination of care between territorial providers ensures optimal use of resources and improves quality of integrated healthcare, also in SID population.ACP for persons with SID is attainable and useful to fit values, preferences and satisfaction of patient’s relatives and legal representatives.This collaborative project has been a great encouragement for working on integration between professionals from different services and thereby it has been able to acquire a better knowledge of all available resources, enabling better responses and more appropriate clinical management in the patients journey through the health care system.As a result of the work done, the relationship between different care agents has significantly improved as well as has increased the satisfaction and security of family members and centre professionals.Conclusion: (include comments on sustainability and on transferability) Care given in a integrated, integral and person-centered vision is effective, efficient and satisfactory in patients with SID profile.The implementation of interdisciplinary teamwork programs in SID residential facilities involving primary care, intermediate care, hospital and emergency services as well as social facilities in the community is feasible, increases the quality of care and is associated with a better management of patient’s morbidity.

Resics Project

Introduction: The population ageing in Catalonia, the current profile of the user of the nursing homes and their heterogeneity, require an improvement of the current residential care model. The need of optimizing the financial resources, the improvement of the primary health care professionals’ intervention on institutionalized patients, the rise of both healthcare quality and user’s satisfaction makes the Catalan Public Health System guarantee a high quality integral health care for people institutionalised in nursing homes, reorienting the care model in order to promote a specific intervention in this group with a high percentage of comorbidity and high health expenditure.The increase of life expectancy determines a rise of chronical diseases, fragility, and functions loss (both physical and mental).The economic impact forces us to develop structures and organizations that adapt efficiently, creating a new integrating culture of health and social services in the residential environment.The change: Our work aims to achieve integral coordination between Primary Care Services and Nursing Homes for the Elderly that allows improving health results, increase users’ satisfaction, and reduce costs.The project’s overall aim is to create a healthcare network between Primary Health Care Services and South Hospitalet’s UGEAP’s nursing homes focusing their attention on the patient, improving care results, and optimizing public resources.Initially a pilot project is in progress between Feixa Llarga Residence and the Primary Care Team Bellvitge. The objectives to be achieved within a period of one year maximum (2015) with different time intervals:Within 1-3 months:• Make an integral assessment of residents• Develop an individualized care plan• Identify complex situation’s residents• Establish systematic meetings between the Residence and EAPWithin 3-6 months:• Agree on clinical practice guidelines and procedures• Establish alliances between EAP/Residence resources• Unify Health and Social terminologyWithin 1 year:• Apply in the residences the defined criteria about the Pharmacological Plan• Extrapolate the model to the rest of the territoryResults: We outline the data within the first 6 months of 2015:- The plan of joint training EAP/RGG agreeing on health and social terminology has been developed and implemented.- Residential Feixa Llarga PCC/MACA users which depend on CAP Bellvitge have been identified.- A medical case manager has been created as someone who coordinates resources.- 5 joint procedures and circuits have been created in order to treat most prevalent problems of residents.- Avoidable emergency referrals have been reduced getting from 65 cases a year to eight cases in six months (significant decrease of ambulances, emergency, and hospital stays costs)- The average of defunctions on the RGG is 25 people per year. The decrease of the total defunctions of RGG deceased at the hospital is a significant 19% to 7.69%.- The total pharmacy expenditure caused by choosing the most cost-efficient drug following clinical practice guidelines, for a more exhaustive control of the drugs’ stock, to decrease prices by pharmaceutical laboratories requested by current regulations, and to increase the training of professionals in the rational use of medicines, has decreased.o Reduction of total pharmacy cost of 24%o Reduction of total chronic drug cost of 23%o Increase of acute drugs cost of 10%Conclusions: A continuity of care has been ensured by detecting high levels of users’ and professionals’ satisfaction because of the simplification that has meant the introduction of new circuits, which optimize resources and reduce costs.The professionals involved have increased their trainings since they have followed a specific training process; they have created spaces of communication between the different teams involved in the care of residents/patients chronically institutionalized.The study considers data and results of the first six months of 2015, which should be completed by the 31st December 2015 in order to compare complete annuities with data from the study RESFEI 10-14 (data from Feixa Llarga Residence).We want to highlight the interest shown by other residential of the territory to be added to the project’s implementation in the future, as well as other UGEAP. It is intended to extrapolate this model to the whole territory of the city of Hospitalet de Llobregat and its residential centers and later on to the whole territory of SAP DELTA.

Salud en Todas las Políticas e intersectorialidad en la promoción de la salud: el Plan Interdepartamental de Salud Pública (PINSAP) de Cataluña

In February 2014, the autonomous government in Catalonia, the Generalitat de Catalunya, approved the Catalan Public Health System Interdepartmental Plan (PINSAP, as per the Catalan acronym), responsible for the strategy in Catalonia for Health in All Policies, as recommended by the WHO and other international institutions. The PINSAP, as outlined under the Catalan Public Health Law, is binding for the government. The Plan was drawn up by the Interdepartmental Health Commission (CIS, as per the Catalan acronym) and is a collaboration between all Departments of the Generalitat. The Plan also receives contributions from 42 local, social and scientific bodies. Apart from the specific initiatives performed by each department which have a greater impact on health, the Plan proposes 30 initiatives, which are defined by their collaboration between public sectors, targeting determining health factors and paying special attention to combating inequalities and measuring the impact on health. The PINSAP encourages interdepartmental initiatives and collaboration between public sectors regarding determinants of health. Although it is only in its first year of implementation, many of their initiatives are already up and running and involving many healthcare professionals in Catalonia.

Six-Year Follow-up of Slaughterhouse Surveillance (2008-2013): The Catalan Slaughterhouse Support Network (SESC).

Meat inspection has the ultimate objective of declaring the meat and offal obtained from carcasses of slaughtered animals fit or unfit for human consumption. This safeguards the health of consumers by ensuring that the food coming from these establishments poses no risk to public health. Concomitantly, it contributes to animal disease surveillance. The Catalan Public Health Protection Agency (Generalitat de Catalunya) identified the need to provide its meat inspectors with a support structure to improve diagnostic capacity: the Slaughterhouse Support Network (SESC). The main goal of the SESC was to offer continuing education to meat inspectors to improve the diagnostic capacity for lesions observed in slaughterhouses. With this aim, a web-based application was designed that allowed meat inspectors to submit their inquiries, images of the lesions, and samples for laboratory analysis. This commentary reviews the cases from the first 6 years of SESC operation (2008-2013). The program not only provides continuing education to inspectors but also contributes to the collection of useful information on animal health and welfare. Therefore, SESC complements animal disease surveillance programs, such as those for tuberculosis, bovine cysticercosis, and porcine trichinellosis, and is a powerful tool for early detection of emerging animal diseases and zoonoses.

How does perceived informational and managerial continuity affect quality of care? Patients’ opinions on the Catalan public health services

How does perceived informational and managerial continuity affect quality of care? Patients’ opinions on the Catalan public health services

A13 Attention Model In Huntington Disease

<h3>Background</h3> Huntington’s disease (HD) is a rare genetic neurodegenerative disease. Due to its clinical complexity, planning a specific care model becomes a challenge. The main HD characteristics are: clinical complexity (affecting motor, cognitive, psychiatric and functional dimensions) heritability (with significant impact in relatives), dynamism (alternating stability periods with crisis, mainly psychiatric) and comorbidity during the final stages of the disease. Its limited prevalence and geographic dispersion might also be taken into account regarding the attention model. <h3>Aim</h3> Describe the development and present situation of the Attention Model in Catalonia. <h3>Methods/techniques</h3> Barcelona Health Authorities invited different experts to constitute a working group. Main goals were: review reference documents, estimate the number of people attended by different health providers, define the resources’ portfolio, define main profiles of patients at the different clinical stages of the disease and generate clinical and care trajectories. At the same time, the Spanish National Rare Disease Strategy was approved and one year later the Catalan Model in Rare Diseases was published. <h3>Results/outcomes</h3> There is a lack of data on health information systems to estimate the real number of patients with HD in our area. The service portfolio includes resources such as primary care, general hospital (neurology, internal medicine, surgery, and nutrition services), mental health resources, socio-health services, day hospital, long term care units, social services, and patients’ associations. Different clinical profiles were defined depending on main symptomatology expressed at any stage of the disease from presymptomatic to end of life. Neuropsychiatric symptoms, comorbidity and functional status clearly influence patient and relatives needs as well as social situation. These needs were also described and the most suitable resource in each clinical situation was recommended, thereby conforming the clinical care trajectories. <h3>Conclusions</h3> The clinical HD complexity and its dynamism imply a multidisciplinary intervention in a comprehensive based attention, making case management essential. Due to the HD low prevalence and its territorial distribution, an equitable healthcare delivery is difficult although epidemiological studies are crucial. Currently, the Catalan Public Health System has incorporated the local Barcelona HD Model as an example of Rare Diseases Model Attention. This model is based on assurance of proper care continuity at different stages of the disease and on the existence of a care management team responsible for needs assessment, resource coordination, and patient and relatives accompaniment throughout the continuum of illness. The Huntington’s disease Comprehensive Attention Service in our Hospital is this team in Barcelona. It9s expected that in a short period of time, Health authorities designate Clinical Expert Units in rare diseases, including HD. From this point on, a Catalan HD network will become a reality.

Geographical differences in whooping cough in Catalonia, Spain, from 1990 to 2010

BackgroundWhooping cough is a communicable disease whose incidence has increased in recent years in some countries with vaccination. Since 1981, in Catalonia (Spain), cases must be reported to the Public Health Department. In 1997, surveillance changed from aggregated counts to individual report and the surveillance system was improved after 2002. Catalan public health is universal with equal coverage geographically. The aim of this study was to determine whether there are differences in whooping cough incidence in rural and urban counties.MethodsCases in 1990–2010 were classified as rural or urban. Incidences and risk ratios (RR) between urban and rural counties and 95% CI were calculated. Associations between rural and urban counties and structural changes during the study period were analysed.ResultsTwelve years of the whole study period showed differences in incidence between rural and urban counties. The incidence was higher in urban counties in seven years and rural counties in five years. There was a positive association of whooping cough incidence in rural and urban counties in four-week periods. Structural changes were detected in the following four-week periods: 4th in 1993, 7th in 1996 and 3rd 2005 in rural counties and 5th 1993, 9th in 1996 and 8th in 2007 in urban counties.ConclusionsDifferences in whooping cough between rural and urban counties were found. In most years, the incidence was higher in urban than in rural counties. Rural and urban counties show similar cyclic behaviour when four-week periods were considered.

Developing a universal tool for the prioritization of patients waiting for elective surgery

The objective was to elaborate a priority scoring system for patients on waiting lists for elective surgery to be implemented in the Catalan public health system. This tool should ideally be universal (for all patients and across the entire region) with common criteria and weights (for all surgical procedures), simple and user-friendly.A tool based on a point-count linear scale ranging from 0 (lowest priority) to 100 (highest priority) was developed. Patients are scored in three major dimensions: clinical and functional impairment, expected benefit, and social role, which include 8 criteria (with their weights): disease severity (23%), pain (or other main symptoms) (14%), rate of disease progression (15%), difficulty in doing activities of daily life (14%), probability and degree of improvement (12%), being dependent with no caregiver (5%), limitation to care for one's dependents (if that be the case) (8%), and limitations in the ability to work, study or seek for employment (9%). As in previous studies developed in Canada, New Zealand and Catalonia, the tool obtained is mainly based on severity and need. The success of this tool depends very much on implementation mechanisms. Furthermore, prior to implementation, a definition of specificities in the selected criteria for the most frequent surgical procedures is advised.